Jeffrey (not his real name) came to treatment complaining of depression, anxiety and trouble getting along with others. Colleagues in the engineering department where he worked complained he was “not a team player,” and his wife saw him as distant and hypercritical. Beyond this, he carried with him a constant feeling of dread, no matter how well things were going.

I agreed with Jeffrey that his dread seemed out of proportion to anything that was actually happening in his life and suggested it might be in proportion to something that was not immediately obvious to either of us. I asked him to tell me about himself. Among other things, I learned that his father had been an alcoholic who would attack without warning, driving Jeffrey to leave home at an early age.